Nervenarzt最新文献

The International Statistical Classification of Diseases and Related Health Problems version 11 (ICD-11) represents a conceptual advance over ICD-10 in the classification of dementias. Although the syndromic classification in the chapter "Neurocognitive disorders" remains in principle unchanged, the introduction of severity levels and the central positioning of mental and behavioral symptoms enables a more precise coding of the clinical diagnoses. Furthermore, the introduction of mild neurocognitive disorder as a prodromal state of dementia is new. The clinical criteria developed by international experts, e.g., for frontotemporal dementia or Lewy body disease, are not yet sufficiently included in ICD-11. Biomarkers for the etiological diagnostics of dementia are also not mentioned, so that it is unclear which role they play in the disease classification in ICD-11. Due to the rapid development in the field of neurodegenerative diseases, regular updates would be desirable.

The classification of psychotic disorders has undergone a variety of changes. Since Karl Ludwig Kahlbaum's (Kahlbaum 1874) first descriptions of catatonic states and Emil Kraepelin's (Kraepelin 1883) nosological classification of psychotic syndromes in the second half of the nineteenth century, the diagnostic criteria for these disorders have been repeatedly modified, significantly impacting clinical practice. Eugen Bleuler (Bleuler 1911) coined the term "schizophrenia", emphasizing the disturbances in thinking, feeling and acting that he had observed. With the introduction of the 11th version of the International Classification of Diseases (ICD-11), several significant changes to the diagnostic criteria were introduced. First-line symptoms according to Schneider lost importance. The subtypes (e.g., paranoid, hebephrenic and catatonic schizophrenia) were also omitted and symptom and progression classifiers have been introduced instead. Finally, catatonia is now defined as an independent diagnostic entity, while in ICD-10 it was still assigned to schizophrenia under the code F20.2. This recognizes catatonia's independent, cross-diagnostic nature. Due to these symptom and progression classifiers, the ICD-11 now takes a more a hybrid categorical and dimensional approach to the diagnosis than the previous version.

With the introduction of the 11th revision of the World Health Organization (WHO) "International Statistical Classification of Diseases and Related Health Problems" (ICD-11), structural and content-related adjustments were made to the diagnostic guidelines for affective disorders, which are presented in this review article. The update has resulted in some changes to the diagnostic classification of affective disorders, based on the American Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). The ICD-11 assigns depressive symptoms to so-called clusters, the main symptoms of depressed mood and joylessness can be accompanied by cognitive, behavioral or neurovegetative symptoms. In the case of remission of depressive episodes, the ICD-11 distinguishes between partial and complete remission. A persistent depressive disorder is present if the depressive episode lasts continuously for more than 2 years. In future, bipolar disorder will be divided into type I and type II. Manic episodes can still only be coded in the context of bipolar disorders and cannot be diagnosed as an independent, separate disorder. The concept of persistent affective disorders in the ICD-10 is abandoned, dysthymia is categorized as a depressive disorder and cyclothymia as a bipolar disorder.

In the ICD-10 the developmental disorders are categorized under three different chapters: F7 for mental retardation, F8 for developmental disorders and F9 for disorders with onset in childhood and adolescence. In ICD-11 neurodevelopmental disorders represent the first new main classification group. The disorders grouped in these categories are all characterized by essentially genetically related atypical patterns of perception, emotional processing, cognition (general and social), language and motor skills. These patterns of mental functioning usually manifest in the first decade of development. They represent persisting characteristics of mental functioning, which can be understood as structural diagnoses. As such, they do not always have pathological significance but must be understood as variants of the norm, at least in less severe cases. In such constellations, they often form the psychodynamic basis for characteristic patterns of interpersonal relationship and communication problems in a subsyndromic expression and hinder the development of valid and constructive identities. These psychodynamics are often associated with interpersonal problems and conflicts as well as classical psychiatric comorbidities, such as stress reactions, adjustment disorders, anxiety disorders, obsessive-compulsive disorders, depression, personality disorders or impulsive and psychotic states. Developmental disorders have a high degree of overlap and comorbidity. This article summarizes the conceptual changes in ICD-11 compared to ICD-10, particularly with respect to the four main subgroups: intellectual disability, autism spectrum disorders, ADHD and tic disorders.

In the ICD-10 the developmental disorders are categorized under three different chapters: F7 for mental retardation, F8 for developmental disorders and F9 for disorders with onset in childhood and adolescence. In ICD-11 neurodevelopmental disorders represent the first new main classification group. The disorders grouped in these categories are all characterized by essentially genetically related atypical patterns of perception, emotional processing, cognition (general and social), language and motor skills. These patterns of mental functioning usually manifest in the first decade of development. They represent persisting characteristics of mental functioning, which can be understood as structural diagnoses. As such, they do not always have pathological significance but must be understood as variants of the norm, at least in less severe cases. In such constellations, they often form the psychodynamic basis for characteristic patterns of interpersonal relationship and communication problems in a subsyndromic expression and hinder the development of valid and constructive identities. These psychodynamics are often associated with interpersonal problems and conflicts as well as classical psychiatric comorbidities, such as stress reactions, adjustment disorders, anxiety disorders, obsessive-compulsive disorders, depression, personality disorders or impulsive and psychotic states. Developmental disorders have a high degree of overlap and comorbidity. This article summarizes the conceptual changes in ICD-11 compared to ICD-10, particularly with respect to the four main subgroups: intellectual disability, autism spectrum disorders, ADHD and tic disorders.

Background: Separation anxiety disorder (SEPAD) is characterized by pronounced fear or anxiety concerning separation from attachment figures. Despite its high lifetime prevalence, adult SEPAD often remains undetected due to a lack of diagnostic tools in multiple languages. The Adult Separation Anxiety Questionnaire (ASA-27) is a key instrument for assessing symptoms of SEPAD in adults. However, no validated German version is available.

Objectives: This study addressed the translation and validation of the ASA-27 in a German-speaking population to introduce the first German questionnaire assessing SEPAD.

Materials and methods: A consecutive forward and backward translation was conducted. Reliability and validity of the German ASA-27 against several established anxiety-related psychometric scores were assessed in a large sample of 1520 healthy participants.

Results: Results revealed robust internal consistency (Cronbach's α = 0.87) and a factor structure explaining 49.7% of variations in answers. Concurrent validity was confirmed through significant correlations with established anxiety measures. Younger age and female sex were positively correlated with ASA-27 scores.

Conclusion: The German ASA-27 constitutes a promising diagnostic tool for adult SEPAD with sound psychometric properties and a coherent factor structure, offering a structured and reliable assessment of SEPAD and its dimensional evaluation in German-speaking populations.

The current article reviews adjustments that were made to the classification of sleep disorders in the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) in comparison to the 10th revision of the coding system (ICD-10). A new chapter on sleep-wake disorders was introduced as chapter 7 in ICD-11, removing the distinction in nonorganic and organic sleep disorders that was used in ICD-10. The rationale for this was the commonsense notion that clinicians and researchers have difficulties to identify the etiology of insomnia and to establish causality between insomnia and coexisting conditions. With respect to sleep disorders that were previously included in chapter V "Mental and behavioural disorders" of the ICD-10, the following important changes were made: the diagnosis of insomnia disorder can now be made as comorbid with other mental disorders or physical illnesses if the insomnia symptoms are a focus of independent clinical attention, non-restorative sleep alone without difficulties initiating or maintaining sleep is not sufficient anymore to diagnose insomnia disorder and new diagnostic categories have been created, including insufficient sleep syndrome and sleep-related eating disorder. Future research will show whether the adjustments in ICD-11 will help clinicians to make reliable and clinically useful diagnoses and whether this improves routine clinical care for sleep disorders.